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007.05.10-36. Specialized Service: Emergency Services.

AR ADC 007.05.10-36Arkansas Administrative Code

West's Arkansas Administrative Code
Title 007. Department of Health
Division 05. Health Facility Services
Rule 10. Rules for Critical Access Hospitals in Arkansas (Refs & Annos)
Ark. Admin. Code 007.05.10-36
007.05.10-36. Specialized Service: Emergency Services.
NOTE: Federal EMTALA requirements apply
A. Every licensed hospital shall have a dedicated emergency department. The following hospitals are excepted:
1. Psychiatric hospitals;
2. Rehabilitation hospitals;
3. Long term acute care hospitals; and
4. Prison hospitals.
B. The hospital's emergency department shall have organized services, procedures, and nationally recognized protocols for emergencies.
C. Diagnostic and treatment equipment, medications, supplies and space shall be adequate in terms of the size and scope of services provided. Resuscitation and life support equipment shall include but not be limited to:
1. Airway control and ventilation equipment including laryngoscope and endotracheal tubes, valve-mask resuscitator, sources of oxygen, pulse oximeter, CO2 monitoring;
2. Suction devices;
3. Standard IV fluids and administration devices, including IV catheters;
4. Intravenous fluid and blood warmers;
5. Sterile surgical sets for standard ED procedures;
6. Gastric lavage equipment; and
7. Blood pressure monitoring equipment.
D. Each emergency department shall have diagnostic imaging and diagnostic laboratory capabilities available twenty-four (24) hours per day, seven (7) days per week. Such laboratory services shall include:
1. Standard analyses of blood, urine, and other body fluids;
2. Blood typing and cross-matching;
3. Coagulation studies;
4. Comprehensive blood bank or access to a community central blood band and adequate hospital storage facilities; and
5. Blood gases and pH determination.
E. An inventory list of all supplies and equipment including all items on the crash cart, shall be checked each shift and after each use.
F. The location and telephone number of the nearest poison control center and a list of poison antidotes shall be posted in the emergency department.
G. Screening examination
Each patient presenting to the emergency department (“ED”) shall have a medical screening examination by a qualified medical personnel. The examination shall be completely documented.
H. Treatment and Disposition
1. If a patient is screened as having an emergency medical condition, a physician shall be contacted to discuss the assessment findings and patient's condition. A physician shall determine disposition of the patient.
2. If a patient is screened as having a non-emergency medical condition, a hospital may allow treatment and disposition of the patient by a physician or non-physician licensed medical professional. This individual must be appropriately credentialed by the medical staff with approval by the governing body to provide non-emergent medical care in the Emergency Department.
I. Physician availability
1. Arrangements shall be provided, such as a duty or on-call roster, to ensure a physician is available for all emergency patients as determined by the screening examination.
2. Arrangements shall be made for obtaining specialized medical services.
J. Staffing.
1. The Emergency Service shall be under the supervision of a Registered Nurse.
2. All patient care personnel assigned to the emergency department shall receive orientation and be competent in life support measures.
3. An Advanced Cardiac Life Support (ACLS) or Pediatric Advanced Life Support (PALS) (as appropriate) trained person shall be in-house and immediately available.
4. The Registered Nurse shall assume the responsibility for the nursing functions of the Emergency Services. This includes:
a. Supervision;
b. Evaluation of the patient's emergency nursing care needs;
c. The assignment of nursing care for each patient to other nursing personnel in accordance with the patient's needs and the preparation and competence of the nursing staff;
d. Supplies and equipment;
e. The emergency department record (See Section 7, General Administration and Sections 15, Medical Record Requirements for Outpatient Services, Emergency Room and Observation Services.); and
f. Maintenance of an emergency department log.
5. Emergency Medical Technician (EMT). Pursuant to the Arkansas Emergency Medical Service Act Ark. Code Ann. §§ 20-13-201 et.seq., if a hospital allows an Arkansas Certified Emergency Medical Technician to perform specified procedures within the Emergency Room or be a member of a hospital code team the following action shall be taken:
a. The Medical Staff shall approve the privileges granted to the individual EMT with concurrence of the hospital's Governing Body. Specific policies governing the supervision and the procedures to be performed by an EMT shall be developed by the Medical Staff and approved by the hospital's Governing Body. In no event shall an EMT perform a procedure that he/she is not certified to do by the Office of Emergency Services of the Arkansas Department of Health;
b. Approved EMT's shall function in accordance with physician's orders and under the direct supervision of either the physician or Registered Nurse responsible for Emergency Services;
c. Students in EMT training programs approved by the Office of Emergency Medical Services of the Arkansas Department of Health shall be trained by qualified instructors within the hospital under guidelines established by the Medical Staff and approved by the Governing Body; and
d. A roster with the delineation of privileges shall be maintained and readily available.
K. Medications. (See Section 16, Pharmacy and Section 12, Medications.)
L. Off-Campus Emergency Departments (off-campus EDs). Off-campus EDs shall meet all requirements for hospital EDs. Off-campus EDs shall:
1. Function as a department of the parent hospital.
2. Be fully integrated into the parent hospital's systems and operations.
a. Medical staff must be part of the parent hospital's single organized medical staff.
b. Nursing personnel must be part of the hospital's single organized nursing service.
c. Emergency laboratory and imaging services must be available 24 hours/day, 7 days/week.
d. Quality assessment/performance improvement (QAPI) program must be integrated into the parent hospital's QAPI program.
e. Records must be maintained as part of the hospital's single medical record system.
f. Infection prevention and control practices must meet the requirements of the parent hospital's infection control policies and practices.
g. Emergency services must meet accepted standards of practice for hospital emergency department.
h. Patients who require further care must have access to all services of the main hospital.
3. Be open 24 hours per day, 7 days per week.
M. Emergency Services Facility. The Arkansas Department of Health may license under Ark. Code Ann. § 20-9-218, hospitals which have discontinued inpatient services to continue to provide emergency services if there is no other hospital Emergency Service in the community.
1. The Emergency Services Facility shall be subject to inspection and to all other provisions of Ark. Code Ann. §§ 20-9-201 et. seq. and 20-13-201 et. seq., as amended.
2. The Emergency Services Facility shall have agreements with licensed hospitals to accept patients who are in need of inpatient hospital services.
3. An emergency facility shall not have licensed inpatient beds, however, at least one holding/observation bed shall be provided for patient use not to exceed 24 hours.
4. Emergency Service Facilities shall provide, or contract to provide emergency ambulance services licensed by the Arkansas Department of Health, that include radio communication and patient telemetry. It is further required that contractual agreements be made for patient air transport services.
5. Policies and procedures shall be developed and approved by Health Facility Services of the Arkansas Department of Health, prior to issuance of a license, and the facility may not provide services without a license.
6. Clinically relevant educational program shall be conducted on a regularly scheduled basis not less than 12 per year. There shall be evidence of program dates, attendance, and subject matter.
7. There shall be an ongoing QA/PI program that is specific to the patient care administered.

Credits

Amended Jan. 1, 2016.
<Statutory authority: Promulgated under the Authority of Ark. Code Ann. § 20-7-123, 20-9-201 et seq.>
Current with amendments received through May 15, 2024. Some sections may be more current, see credit for details.
Ark. Admin. Code 007.05.10-36, AR ADC 007.05.10-36
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